A Review of Back Pain Solutions, by Bruce Kodish PhD., P.T.

Barrett L. Dorko, P.T.

I figured out a while ago that there are several ways to become an exceptional clinician, and all of them have just one thing in common; the ability to communicate profoundly with the patient. To me, this is the thing that separates the expert from the novice and it is undoubtedly the most difficult skill to master. When I examine my own failures as a clinician, I almost always find that this is where I have fallen short.

To my knowledge, there has never been a book about the treatment of back pain written by an expert in communication. That is, until now.

Bruce Kodish, Ph.D., P.T. is an award-winning teacher of General Semantics, a certified teaching member of The American Society for the Alexander Technique and is also certified in Mechanical Diagnosis and Therapy (MDT), often called McKenzie Technique. The latter two are familiar to our community, but General Semantics is not. I want to discuss it briefly, and eventually connect it to what Dr. Kodish accomplishes in this book.

Following World War I a Polish engineer, Alfred Korzybski, settled in the United States. Appalled by the massive destruction he’d seen in Europe, he was determined to answer the question of how humans so successfully advanced technologically still managed to make such a mess of their human affairs. He developed General Semantics, which, in my experience, is best described in quotes by others. Let’s try one from Wendell Johnson: “General semantics may be regarded as a systematic attempt to formulate the general method of science in such a way that it might be applied not only in a few restricted areas of human experience, but generally in daily life. It is concerned with science as a general method, as a basic orientation, as a generalized way of solving problems.”
For me at least, this is a difficult concept to absorb, so I’ll give you another from Kodish’s Emptying Your Cup: Non-Verbal Awareness and General-Semantics: “General-semantics includes both a comprehensive theory of how we conduct our lives, for better and worse, and a set of techniques for increasing our better functioning and reducing our dysfunctioning. Language plays a central role in these formulations, as does focus on our non-verbal experiencing. We learn about how these relate to what is going on in and around us. This knowledge leads to a greater ability to deal with uncertainty, better decision-making and generally more successful living.”

It is Kodish’s ability to “deal with uncertainty” that initially impresses me about this book and the manner in which it is written. Given his certification in MDT, you might expect an approach focused on the connective tissue or the simpler descriptions of postural alignment. But this book carefully explores many avenues of care, and it does so with language worthy of Korzybski’s vision. Throughout, Back Pain Solutions offers a wide array of answers for a common problem. My dictionary defines solution as “a homogenous mixture of varying proportions.” Kodish manages to mix a remarkable variety of ideas, tests and procedures that continually focus on the experience of back pain from the perspective of both the patient and therapist. In order to create a “solution” that honors so many modes of thinking, and thus seeks the best approach for the patient’s individual problem, the therapist must truly know the breadth of practice and somehow reconcile its often discordant elements. I know I’ve never been able to do this, but Kodish explains in a passage early in the book how he sees things: “A growing number of healthcare practitioners advocate what they call ‘evidence’-based practice. It seems ironic that some advocates of this approach emphasize the usefulness of only one form of evidence: information gained from the statistical study of large groups of people. …If you want to know if a particular treatment works on the average, you need this kind of study. However, there is information that can never be gotten from doing this kind of research. Statistical studies will never tell you how a treatment works or how an individual functions, although it may suggest ideas. …Depending too much on group statistical methods thus promotes a generic approach…” Believe me, there is nothing generic about Kodish’s approach to backache.

In General Semantics, the uncertainty of meaning in communication is dealt with carefully and continuously. This takes a thorough understanding of nuance, inflection, sequence and unconsciously generated messages. For me, the management of back pain has always required careful and continuous study. Perhaps it is this kind of discipline that lies behind Kodish’s achievement.

This is a book with information appropriate for both student therapists and clinical experts. The references are extensive, the reasoning unassailable, and, not surprisingly, the writing is perfectly clear. Bruce Kodish seems to have done what only a therapist with his diverse and comprehensive training could do, and now it’s available for the rest of us.

To order Back Pain Solutions: How to help yourself with posture-movement therapy and education by Bruce Kodish, Ph.D., P.T. go to http://www.backpainsolutions.net or write Extensional Publishing P.O.Box 50490 Pasadena, CA 91115-0490